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Anaphylactoid reactions during hemodialysis
R M Schaefer1, L Schaefer, W H Hörl
1Abteilung Innere Medizin, Universität Münster, Germany.
Clinical Nephrology
|July 1, 1994
Summary
A novel hypersensitivity reaction can occur during extracorporeal therapy when using ACE inhibitors with negatively charged biomaterials. This interaction elevates bradykinin, potentially causing severe anaphylaxis in dialysis patients.
Area of Science:
- Nephrology
- Pharmacology
- Biomaterials Science
Background:
- Angiotensin-Converting Enzyme (ACE) inhibitors are widely used in dialysis patients.
- Extracorporeal therapies, including hemodialysis, often involve biomaterials.
- Hypersensitivity reactions during these therapies are a recognized clinical concern.
Purpose of the Study:
- To identify the mechanism behind a novel hypersensitivity reaction observed during extracorporeal therapy.
- To elucidate the role of ACE inhibitors and biomaterials in these reactions.
- To provide clinical guidance for managing and preventing adverse events.
Main Methods:
- Review of clinical data and known pharmacological pathways.
- Analysis of the interaction between negatively charged biomaterials, Factor XII activation, and bradykinin metabolism.
- Assessment of the impact of ACE inhibitors on bradykinin levels during dialysis.
Main Results:
- Negatively charged biomaterials activate Factor XII, leading to bradykinin generation.
- ACE inhibitors block the degradation of bradykinin by kininase II (identical to ACE).
- In patients on ACE inhibitors, plasma bradykinin levels can increase over 100-fold during dialysis with specific membranes, leading to severe anaphylaxis.
Conclusions:
- The combination of negatively charged biomaterials and ACE inhibitor therapy can precipitate severe hypersensitivity reactions.
- Avoiding this combination in clinical hemodialysis is crucial for patient safety.
- Alternative biomaterials are available, making this avoidance feasible in clinical practice.